Comparison of Pentax Airway Scope and Macintosh laryngoscope for orotracheal intubation in children: A randomised non‐inferiority trial

Yi, In Kyong; Kwak, Hyun Jeong; Kim, Kyung Mi; Ahn, Soo Hwan; Lee, Sook Young; Kim, Jong Yeop

doi:10.1111/aas.13368

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…Of the 23 included studies, 20 studies 12 – 14 , 30 – 39 , 41 – 44 , 46 , 47 , 49 explicitly reported methods for generating random sequence, and 13 studies 13 , 31 , 32 , 34 , 35 , 37 – 40 , 42 , 43 , 47 , 48 described methods for performing allocation concealment. Most studies 12 – 14 , 30 – 43 did not blind participants and personnel.…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, a total of 16 studies 11 , 13 , 14 , 30 – 35 , 38 – 40 , 42 , 43 , 46 , 47 , involving 1288 patients, reported the data of LC for 10 intubation devices. Network meta-analysis suggested that Airtraq significantly reduced the risk of LC compared with Macintosh (OR = 0.14, 95%CI = 0.03 to 0.69) and Pentax (OR = 29.17, 95%CI = 1.93 to 440.66).…”

Section: Resultsmentioning

confidence: 99%

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Network meta-analysis of comparative efficacy and safety of intubation devices in children

Ming,

Chu,

Yang

et al. 2023

Sci Rep

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To evaluate the comparative efficacy and safety of different intubation devices on intubation outcomes in pediatric intubation. We identified relevant studies from previous meta-analyses and literature retrieval in PubMed, EMBASE, and Cochrane Library. The primary outcome was the first-pass success (FPS), and the secondary outcome included the time to intubation (TTI) and the risk of local complications (LC). Network meta-analysis was performed using STATA 14.0. Twenty-three randomized comparative trials (RCTs) including 12 devices were included. Compared with Macintosh, Airtraq (odds ratio [OR] = 13.05, 95% confidence interval [CI] = 4.68 to 36.38), Miller (OR = 4.77, 95%CI = 1.32 to 17.22), Glidescope (OR = 2.76, 95%CrI = 1.60 to 4.75) and McGrath (OR = 4.61, 95%CI = 1.18 to 17.99) obtained higher PFS. Meanwhile, Airtraq was superior to Glidescope (OR = 0.21, 95%CI = 0.07 to 0.65) for PFS. For TTI, Canada was superior to other intubation devices, as well as CMAC was superior to TruViewEVO2, Glidescope, and StorzDCI. Airtraq lowered the risk of LC compared with Macintosh and Pentax but there was no statistical difference between Airtraq and KingVision. Airtraq may be the optimal option for FPS, Canada for TTI, and KingVision for LC in pediatric intubation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Network meta-analysis of comparative efficacy and safety of intubation devices in children

Ming,

Chu,

Yang

et al. 2023

Sci Rep

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“…A further 202 studies were excluded for the following reasons: non-RCT (n = 56), manikin study (n = 41), case report (n = 33), review or meta-analysis (n = 22), different outcomes (n = 16), use of a flexible fiberscope (n = 11), use of a laryngeal mask (n = 7), observational study design (n = 7), adult patients (n = 4), guidelines (n = 3), and resuscitation research (n = 3). The remaining 34 articles met the inclusion criteria and contained the data necessary for the planned analysis ( Figure S3 ) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patients included in these studies were aged 0 to 10 years. Based on pre-intubation airway assessment, 26 of 34 studies included patients with a normal airway [ 15 , 16 , 17 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 46 , 47 ], and 3 included patients with a difficult airway [ 35 , 36 , 45 ]. Five studies did not provide information on airway status [ 18 , 19 , 21 , 34 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis

et al. 2022

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This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was intubation failure at the first attempt. Secondary outcomes were glottic visualization and intubation time. The statistical analysis performed used DerSimonian and Laird random-effects models. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. Subgroup analysis was performed after excluding rigid-fiberscope-type indirect laryngoscopes. Thirty-four trials comparing 13 devices were included. Most laryngoscopes had the same intubation failure rate as the Macintosh reference device. Only the Truview PCD™ had a significantly higher intubation failure rate than the Macintosh (odds ratio 4.78, 95% confidence interval 1.11–20.6) The highest-ranking laryngoscope was the Airtaq™ (P score, 0.90), and the AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than the Macintosh. The Bullard™ had the lowest ranking (P score, 0.08). All laryngoscopes had the same level of glottic visualization as the Macintosh and only the C-MAC™ had a significantly shorter intubation time. Intubation time was significantly longer when using the GlideScope™, Storz DCI™, Truview PCD™, or Bullard™ compared with the Macintosh. P score and ranking of devices in the subgroup analyses were similar to those in the main analysis. We applied NMA to create a consistent ranking of the effectiveness of intubation devices in pediatric patients. The findings of NMA suggest that there is presently no laryngoscope superior to the Macintosh laryngoscope in terms of tracheal intubation failure rate and glottic visualization in pediatric patients.

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“… • C-MAC® with Macintosh blade A • GlideScope® DVM B Hyper-angulated or hyper-curved blade video laryngoscopy (HA-VL) Hyper-angulated blade VL (HA-VL) allows “around the corner” viewing of the glottis by indirect, videoscopic viewing only. The view with HA-VL is often superior to that obtained by DL 115 – 117 or Mac-VL. 117 First pass tracheal intubation success with HA-VL is frequently higher than with DL.…”

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 86%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. Findings and key recommendations Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider “exit strategy” options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a “cannot ventilate, cannot oxygenate” emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as “airway lead” to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.

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Comparison of Pentax Airway Scope and Macintosh laryngoscope for orotracheal intubation in children: A randomised non‐inferiority trial

Cited by 6 publications

References 23 publications

Network meta-analysis of comparative efficacy and safety of intubation devices in children

Network meta-analysis of comparative efficacy and safety of intubation devices in children

Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

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